Less-Tight versus Tight Control of Hypertension in Pregnancy
Less-Tight versus Tight Control of Hypertension in Pregnancy
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DOI：
10.1056/nejmoa1404595
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发表时间：
2015-01-29
影响因子：
158.5
通讯作者：
Moutquin, Jean-Marie
中科院分区：
文献类型：
--
作者：
Magee, Laura A.;von Dadelszen, Peter;Moutquin, Jean-Marie
GroundThe效果不太严格与严格控制的高血压对妊娠并发症还不清楚methodsWe进行了一项开放的，国际性的，多中心的试验涉及妇女在14周0天至33周6天的妊娠谁有非蛋白尿预先存在或妊娠高血压，办公室舒张压90至105 mm Hg（或85至105 mm Hg，如果妇女正在服用抗高血压药物）和活胎。妇女被随机分配到不太严格的控制（目标舒张压，100毫米汞柱）或严格控制（目标舒张压，85毫米汞柱）。复合主要结局为产后前28天内妊娠丢失或高水平新生儿护理超过48小时。次要结局是产后6周或出院时发生的严重母体并发症，以较晚者为准。纳入分析的987名妇女中，74.6%有既往高血压。在493名被分配到不太严格控制组的妇女和488名被分配到严格控制组的妇女中，（分别为31.4%和30.7%;校正比值比，1.02; 95%置信区间[CI]，0.77 - 1.35），以及严重母体并发症的发生率（分别为3.7%和2.0%;校正比值比，1.74; 95%CI，0.79至3.84），尽管平均舒张压在控制不严格的组中高出4.6 mm Hg（95%CI，3.7至5.4）。对照组中40.6%的妇女发生重度高血压（≥ 160/110 mm Hg），对照组中27.5%的妇女发生重度高血压（≥ 160/110 mm Hg）（P
BACKGROUNDThe effects of less-tight versus tight control of hypertension on pregnancy complications are unclear.METHODSWe performed an open, international, multicenter trial involving women at 14 weeks 0 days to 33 weeks 6 days of gestation who had nonproteinuric preexisting or gestational hypertension, office diastolic blood pressure of 90 to 105 mm Hg (or 85 to 105 mm Hg if the woman was taking antihypertensive medications), and a live fetus. Women were randomly assigned to less-tight control (target diastolic blood pressure, 100 mm Hg) or tight control (target diastolic blood pressure, 85 mm Hg). The composite primary outcome was pregnancy loss or high-level neonatal care for more than 48 hours during the first 28 postnatal days. The secondary outcome was serious maternal complications occurring up to 6 weeks post partum or until hospital discharge, whichever was later.RESULTSIncluded in the analysis were 987 women; 74.6% had preexisting hypertension. The primary-outcome rates were similar among 493 women assigned to less-tight control and 488 women assigned to tight control (31.4% and 30.7%, respectively; adjusted odds ratio, 1.02; 95% confidence interval [CI], 0.77 to 1.35), as were the rates of serious maternal complications (3.7% and 2.0%, respectively; adjusted odds ratio, 1.74; 95% CI, 0.79 to 3.84), despite a mean diastolic blood pressure that was higher in the less-tight-control group by 4.6 mm Hg (95% CI, 3.7 to 5.4). Severe hypertension (>= 160/110 mm Hg) developed in 40.6% of the women in the less-tight-control group and 27.5% of the women in the tight-control group (P